Transmastoid Endoscopic Approach to a Petrous Apex Cholesteatoma

Objective: Cholesteatomas account for 4 to 9% of petrous apex lesions. The purpose of this study was to assess the ability to treat a petrous apex cholesteatoma through a transmastoid endoscopic approach.

Materials and Methods: We report the case of a 36-year-old man with a history of left chronic otitis media and canal wall down tympanoplasty for cholesteatoma 23 years before. He complained of headache and sudden episodes of vertigo for 3 weeks. Computed tomography (CT) showed a soft tissue mass located into the left mastoid anterior to the sigmoid sinus and into the petrous apex with foci of bone destruction. Magnetic resonance (MR) imaging showed a nonenhancing soft tissue mass of the mastoid and the petrous apex with high signal intensity in T2-weighted and coronal diffusion-weighted images.

Results: The mass was surgically removed via a transmastoid retrolabyrinthine endoscopic approach with hearing preservation, and the cavity was filled with Gelfoam and fibrin glue. After surgery, the patient had no complications due to the surgery. Definitive histopathology demonstrated the classic appearance of cholesteatoma and follow-up images; 1 year after surgery, he showed no signs of recurrence.

Conclusion: A transmastoid endoscopic approach is a safe, minimally invasive procedure to treat a petrous apex cholesteatoma. The operative space was pneumatized completely within several months by obliteration with fibrin glue. This simple procedure allows easy observation and evaluation of the postoperative region with CT and MR for follow-up of recurrence of cholesteatoma and an easier access to the region in case of recurrent cholesteatoma.